Form 0750 Sample - Performance Appraisal Program (Page 4 of 6) in pdf

Form 0750 Sample - Performance Appraisal Program Page 4

SECTION C - ACTUAL ACHIEVEMENT

Indicate the single, overall level of achievement that best describes the employee's performance for each ELEMENT shown in Section A. Do not

indicate achievement for each individual standard. Specific examples of performance must be provided in the space below for each element where

a level of achievement other than Fully Successful has been assigned. Assignment of the Exceptional level means that Fully Successful

performance standards have been significantly surpassed. This level is reserved for employees whose performance in the element far

exceeds normal expectations and results in major contributions to the accomplishment of organizational goals.

LEVELS OF ACHIEVEMENT

ELEMENTS

LESS THAN

FULLY

EXCEPTIONAL

(Use the same key word description for each element as in Section A)

FULLY

SUCCESSFUL

Interpersonal Effectiveness

Correspondence Preparation

Customer Service

SAMPLE

Safety

Describe specific examples of performance for each element where a level of achievement other than Fully Successful has been assigned above.

Specific achievements at the Fully Successful level may be described.

ELEMENTS/ACHIEVEMENT(S)

Joe normally responds to veterans inquiries within 10 days of the inquiry.

There were 8

instances where he was untimely.

4% of his letters required content correction or

clarification.

Most of his communications were provide in a prompt manner.

There were no instances of inappropriate release of veteran medical information.

Joe

left his computer on one time when he went on break and a patient sat down at his work

station and was looking at his file.

I received one documented complaint from a veteran about how Joe treated a veteran.

received three documented complaints from employees about interactions with Joe.

Normally Joe responds to customer feedback within 3 days.

Joe monitors the technical aspects of the USAA/Hartford program with no more than 2

exceptions per month.

USAA/Hartford reports, records, and files are accurate so they

don't require content correction or clarification more than 2 times per month.

VA FORM 0750, NOV 2003

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Form 0750 Sample - Performance Appraisal Program Page 4